Menopause: Symptoms, Diagnosis, and Treatment

Menopause is not a disease – it is a natural part of every woman's life. However, the changes it brings can be confusing, uncomfortable, and sometimes concerning. What exactly is menopause? When does it begin and how does it manifest? Is there a way to alleviate symptoms and maintain health during and after this period? In the following text, find everything you need to know about the symptoms, diagnosis, and modern treatment options for menopause.

What is Menopause?

Menopause marks the end of the menstrual cycle and is the natural conclusion of the reproductive period in a woman's life. A woman is considered to have entered menopause if she has not had a menstrual period for one year. Menopause occurs when the ovaries stop releasing eggs and producing the hormones estrogen and progesterone, which regulate the menstrual cycle. It typically occurs between the ages of 45 and 55, with the average age being 52. However, it can also happen earlier, either naturally or as a result of surgery or treatments such as chemotherapy. If it occurs before the age of 40, it is called premature menopause. Natural menopause progresses gradually and is not caused by medical treatments. It occurs in three phases (Gatta, 2025):

• Perimenopause: This phase marks the transition into menopause. It starts several years before menopause when the ovaries gradually reduce estrogen production. On average, this phase lasts about four years and can be accompanied by various physical and emotional changes. Towards the end of this phase, menopause symptoms become more pronounced.
• Menopause: This is the moment when 12 months have passed without menstruation. The ovaries stop releasing eggs and producing most of the estrogen.
• Postmenopause: This period follows menopause. Symptoms mostly subside, but the risk of health problems associated with reduced estrogen levels increases.

Premature and Early Menopause

The absence of a menstrual cycle in your forties doesn't necessarily mean pregnancy – it could be a sign of early menopause. Around 5% of women enter menopause between the ages of 40 and 45, while menopause before 40 is called premature menopause and is rarer. Key signs include irregular cycles: the absence of several periods, changes in cycle length, and changes in the amount of bleeding (heavier or lighter bleeding) (Catlett, 2024). Early menopause can affect fertility. Therefore, if you plan to become pregnant, possible options include egg freezing or in vitro fertilization with donor eggs (Ibid).

In about half of cases, early or premature menopause occurs without a clear cause, while known causes and risk factors for premature and early menopause include (Mitchell, 2023):

• Certain cancer treatments;
• Family history of early menopause;
• First menstruation before the age of 11.

A condition known as premature ovarian insufficiency (POI) can also cause early cessation of menstruation without an obvious medical reason. Unlike true menopause, menstruation may return in some cases, and pregnancy may still be possible (Mitchell, 2023).

Perimenopause

Changes that indicate the transition to menopause can begin months or years before menopause actually occurs. The first symptoms often include hot flashes and night sweats, and you may also notice irregular periods. This transitional period is called perimenopause. It usually begins in the forties, between 45 and 50, although the timing can vary. During perimenopause, it is difficult to predict when your next period will occur, how long it will last, and how heavy it will be. Pregnancy is more difficult but still possible as long as you have periods. If you do not want to get pregnant, you should continue using contraception during perimenopause (Mitchell, 2023).

Physical symptoms of perimenopause may include (Catlett, 2024):

• Changes in breast size or shape;
• Dry eyes;
• Skin redness;
• Hair loss;
• Headaches;
• Hot flashes;
• Increased facial or body hair (hirsutism);
• Rapid heartbeat (palpitations);
• Frequent urination;
• Insomnia;
• Itching;
• Muscle or joint pain;
• Night sweats;
• Pain during penetrative sex (dyspareunia);
• Painful or sensitive breasts;
• Vulvovaginal atrophy, which may cause vaginal dryness;
• Weight gain.

Mental and emotional symptoms may include (Catlett, 2024):

• Anxiety;
• Reduced libido;
• Depression;
• Difficulty concentrating (brain fog);
• Irritability;
• Fatigue;
• Forgetfulness;
• Unpredictable mood swings.

Perimenopause ends when more than 12 months have passed without menstruation, at which point menopause begins (Mitchell, 2023).

Menopause

However, menopause most commonly occurs between the ages of 50 and 55. During this period, women enter menopause or are in its final transition. The ovaries stop releasing eggs and producing estrogen, which can increase the risk of heart disease, osteoporosis, urinary and vaginal infections, and urinary incontinence. Therefore, during this period, it is recommended to consult with a doctor about lifestyle and preventive measures for maintaining health. Late menopause (ages 55-60) occurs in fewer women but is associated with a lower risk of heart disease, osteoporosis, and stroke, as well as a longer lifespan – likely due to the longer presence of estrogen (Catlett, 2024).

Postmenopause

Postmenopause (ages 60-65) begins when more than a year has passed without menstruation. Additionally, blood tests checking for specific hormones can be used to confirm postmenopause (Gatta, 2025). Although changes in postmenopause are milder, symptoms such as hot flashes may still occur. A 2018 study showed that 40% of women at this age still experience these symptoms (Catlett, 2024). Postmenopause lasts until the end of life, but during this period, the risk of heart disease and osteoporosis increases. Lifestyle changes such as a healthy diet and regular physical activity can help reduce this risk (Mitchell, 2023).

Diagnosis and Treatment of Menopause

The first signs of menopause often occur during perimenopause, which can begin years before the last period. Monitoring the symptoms of perimenopause is crucial. A doctor can confirm menopause by analyzing blood tests that check for:

• FSH (follicle-stimulating hormone) – increases during perimenopause;
• Estradiol – decreases as ovarian function declines;
• Thyroid hormones – to rule out thyroid disorders (Gatta, 2025).

Although menopause is not a disease, its symptoms can be uncomfortable. You may consult a doctor if the symptoms of menopause are bothersome and interfere with daily life – such as hot flashes disrupting sleep, mood swings, or body changes affecting sexual life. Some women do not have symptoms that require treatment, and they alleviate them naturally through dietary changes, exercise, and relaxation techniques (Mitchell, 2023). There are various options for relieving symptoms:

• Lifestyle changes – a healthy diet and weight management, limiting smoking and alcohol, regular physical activity, Kegel exercises (to prevent urinary incontinence), lubricants and moisturizers (for vaginal dryness), layered clothing, cold water, and ventilation (to alleviate hot flashes), etc.;
• Hormone Replacement Therapy (HRT) – replaces estrogen and progesterone, alleviates hot flashes, and protects bones, but should be used with caution due to potential risks;
• Local estrogen therapy – in the form of creams, gels, or vaginal suppositories to alleviate dryness and discomfort;
• Non-hormonal medications – such as paroxetine, gabapentin, and clonidine for hot flashes or antidepressants if mood swings are pronounced;
• Osteoporosis therapy – vitamin D and calcium supplements, or medications to strengthen bones (Gatta, 2025; Mitchell, 2023).

Conclusion

Although menopause marks the end of one phase of life, it does not have to mean the end of vitality, sexuality, or good health. Understanding the symptoms, timely diagnosis, and choosing the appropriate treatment can greatly contribute to quality of life. With the support of a doctor, a healthy lifestyle, and an open approach to menopause – this natural process can become an opportunity for a new beginning, not an obstacle.

*This text is for informational purposes only. If you experience any symptoms, it is recommended to consult your doctor or a qualified healthcare professional.

References:

• Hliznitsova, K. (2023, June 11). A woman sitting on a couch holding her hands to her face [Photograph]. Unsplash. https://unsplash.com/photos/a-woman-sitting-on-a-couch-holding-her-hands-to-her-face-v-IK-Zfx_lw
• Mitchell, K. (2023, September 27). How do I know if I'm in menopause? WebMD. https://www.webmd.com/menopause/understanding-menopause-symptoms
• Catlett, T. (2024, April 23). Symptoms of menopause. Healthline. https://www.healthline.com/health/menopause/symptoms-of-menopause
• Gatta, F. (2025, February 6). A complete guide on menopause. WebMD. https://www.webmd.com/menopause/menopause-basics